Affiliation:
1. State University of New York College at Brockport
2. University of Nebraska at Omaha
Abstract
In state implementation of the Affordable Care Act (ACA) health insurance exchanges, sixteen states decided to create and administer their own exchanges, determining the institutional location of the exchanges. This institutional design of implementing organizations affects aspects of state policy implementation of the health exchanges, reflecting the intentions of state officials to exert control over the administration of operations and other decisions such as funding sources. This research examines whether state decisions regarding agency assignment of the ACA health exchanges were associated with political, economic, and historical-cultural explanations. This study provides evidence that, in the decision of the location of health insurance exchanges, state officials were influenced by the factors of state budget shortfalls and state histories of creating independent agencies, but not by divided government, compound divided government and state personnel capacity.
Reference61 articles.
1. Bontrager J., Butcher K. & Schmitt S. (2014). Colorado: Round 1. State-level field network study of the implementation of the Affordable Care Act. Retrieved from http://www.rockinst.org/ACA/states/Colorado/2014-03-Colorado_Round_Onev2.pdf.
2. Divided Government, Interest Representation, and Policy Differences: Competing Explanations of Gridlock in the Fifty States